 I personally didn't know that it's a whole specialty on its own. What is it about? Why we need to take keen, you know, focus or interest on this particular matter? How exactly are we supposed to handle different situations where we have wounds and everything for us and for people around us? Welcome, Dr. Hari. Thank you. Thank you so much. Glad to have you with us. Glad to have you here as well. Ah, so like I have just said and I had told you before, I didn't know that there's a whole, you know, it's a whole specialty that a doctor can specialize in, you know, wound treatment. Tell us a little bit about it. Actually it's an open forum for nurses and doctors. All can specialize, can advance their programs into wound specialties. So it's a science whereby you study more about tissue viability, how tissues heal, making wound heals heal quicker and such. So it's a very interesting docket just to observe wounds heal quick. And like all the methods used whereby you find someone will end up with an amputation or will end up with some very life-threatening situation, now things have been made simpler. Just the same specialty, it has really improved a lot on the care. Okay. And as we go on, you will tell us, you know, what new technologies or what new science has been implemented to improve on this care, particularly care. For starters, tell us the different types of wounds that are there and the best way of treatment for them. This is a very broad question. We categorize wounds, okay, when we're talking about different types of wounds, those that falls under trauma, for instance, cut, we have incisions, surgical and both, maybe from home we've cut ourselves at night with a knife and so forth. Those that falls under burns, I'm very sure you talk about burns, everyone think about fire and something called, this is also burns from chemicals, from radiation, from electricity, even there is what you call negative thermal effect whereby you've been subjected to extreme cold temperatures, you can still have a burn, like frostbite is a kind of a burn, but from a negative thermal effect, then there are those that are caused by predisposed commodities like diabetes, maybe find a low immunity, the vascular conditions like this venous ulcers, arterial ulcers, those are caused by vascular commodities, then we have those that are caused by auto or immune deficiency, like get patients with HIV, some of them normally end up with some funding and healing wounds. So you can categorize according to many ways, so there is burns, we have trauma, those that falls under predisposing comorbids, then we have also pressure ulcers, this is very common, those patients lying in one position for too long or the turning is a little bit difficult, they end up with a pressure ulcer as well, those are type of wounds. Okay, pressure ulcers, that's the first I'm hearing of it. Commonly people know it's bed sores, you've heard of bed sores. Okay, all right, okay, learning. Okay, for all these categories, is there a specific treatment type for let's say burns for the trauma type of wounds? Now that is what we mentioned now, the science of wound healing, the phases that normally observe, some wound follow a specific path of healing, so that is what we manage. For instance, those that are caused by trauma, you find that a wound bleeds, then from bleeding, so this specific, okay, let me don't use so much every time, these are path that they follow to heal. There's a hemostatic phase whereby the body initiates a process to stop the bleeding, then there's an inflammatory phase whereby the body fights back, there is those bacteria introducing the wound or mediators which need to start to initiate growth, those growth factors, that's the second phase, the inflammatory phase, then you have the proliferative phase whereby tissue starts to germinate and grow, then after that we have the maturation phase at the end, already tissues have grown, now they mature up or as formation of scar is being reduced to normal skin, so all wounds have a specific path they follow, so that is what we normally manage, that's why we talk about wound care being a science, so you observe the science, you treat it according to what the course take, in some modules I was talking about they wound speak to us, what it needs is what you give, for instance if there is an infection, treat the infection, if there is non-viable tissue, treat or remove the non-viable tissue, if the wound is healing promote more healing, yes. Okay interesting and you've mentioned a module, so do you teach on this also? Yeah we've partnered with our association so that we can be able to pass on this message across to healthcare practitioners like the national nurses association of Kenya, we reach a lot to nurses and doctors who are interested in this program say come on board and we just pass on the knowledge, it's something which is very key, the other thing that we do, okay I'm an executive member of the foot and limb group salvage, being there we tend to, it's a multidisciplinary approach, you pass on the message across as well to nurses and doctors that we can all be at par, I know not everyone loves wounds but at least when you're having that basic information on management you can be able to help or maybe prevention of complications on such because you have at least the basic information. Okay speaking of preventing further damage to be done, what would you say is the best course of action to take as fast aid for someone who has fresh wound that you've come across, is it something that you should take care of you know as yourself or you know to help a person before they get to a medic that will prevent further damage? For wounds okay what matters as per say is the degree, there are those wounds which you can be able to manage from home, there are those wounds which definitely needs a medical protection at what end to, for instance those superficial by superficial I mean those that just involve the top layer of the skin, those are things that we just hygiene, cleaning even just basic tap water can be able to resolve and covering them don't leave any wound open, you have to cover regardless of how small it is, so for such this ones can be managed from home but wounds that get now to deeper tissues the skin has got like three layers, the epidermis, the dermis and the subcutaneous layer, anything penetrating past the superficial the top layer then it's of interest to be seen by a practitioner, remember there's an issue of now infection, the skin contains a lot of bacteria which if they find broken skin they get inside can really escalate into something completely different, so remember some wounds involved like if it's deep cuts blood vessels, cutting nerves that's why it's important for them to be seen, it might be even not really of concern but at least being seen comes very important, even injection of this tetanus toxin, those are factors that normally want to have done at least within the first 72 hours after a cut if it's penetrating then go to the facility for that. Speaking of tetanus because I was also coming to that you know we know and we've heard that you when especially if it's a metal metallic object that has cut you then you need to get a tetanus injection is it only limited to a metallic object cutting you or do you just need a tetanus injection if the cut is deep what determines the cost of action? Those cuts that occur injuries which compromises the temperature of the skin that you don't know the origin you've fallen down and you have a bruise, a big bruise, you don't have a look it's important to get the shots. That is whether deep or not? Okay we normally overlook ideally any cut but you see you can't we subject ourselves to cuts almost every day you can't be running for injection every other time so there normally like schedules for getting these shots there's a number of this limit your body now can be able to like fight back remember this anomaly some attenuated viruses so they just weaken so the body can be able to like fight back as well so we advocate for these shots because the complications normally let's say one is subjected to not this tetanus itself it's life limiting a life tetanus because it affects the nerves the nervous system becomes compromised and it can compromise not only the limbs including the respiratory system any system with a muscle can be compromised so you find that it is important to protect yourself get this job you have an injury penetrating or you know the object maybe something rusty or maybe some injury which you don't know how you got it but let's say even after an accident or something you ensure the practitioner gives you the job. Okay all right interesting I think I have missed so much I've received so many cuts I've never gone to a tetanus injection. Some might not be really necessary. All right so now how do you because you've said it for you to handle the situation it determined by the severity of the wound how do you for a normal person ordinary person how do you determine that this needs to get medical proper medical attention it's beyond me because you know as Kenyans we know how to treat ourselves we know so much we have all the knowledge and then we assume we know it all but we might get to us so how do you determine the severity of the situation? For open wounds wounds which don't heal like this what I mentioned about the pattern or the path the course in which wound healing takes so a wound which does not follow the sequence it's not tissues are not regenerating or this continuation or continuity of bleeding or some we find that there is some funny fluid coming from the we call purulent exit the common language is pass coming from it these are clear markers that the wound is out of hand and should have been attended to like earlier on so non healing wounds if you're having any even odour or you're having dead tissues some will manifest even by dead tissues this one's should have been seen in the facility that's why we're saying don't have a look any regardless how simple it looks like don't have a look because there might be some other underlying thing that you're not seeing including even small things like pimples like okay not all are just ordinary pimples some got a history behind so those breeze those deep penetrating cuts anything any discoloration the skin it might be something brewing inside so I just have it seen so you can say that this is too I'll soon I can be able to do at home anything you suspect like I know this is way too much for me as in but don't wait until it gets to that just have it looked at okay and we've talked about what we've talked mostly about is on the trauma type of wound and the open wound before we move on to even the buns what about wounds that I don't know if it's closed wounds and you know where you just have how do we call it you have let's say fallen and then you feel pain from inside and then you have enough for Ram Kono something is that also another type of wound that you would say we normally say if if the integrity of skin is not okay by definition we normally define a wound by it's an injury which compromises the normal integrity of the skin so if the integrity of skin is not compromised it's not a wound but remember there's some physiology switch or some path of physiology switch manifests they begin from inside like something is happening on the inside but eventually it ruptures out causing now a physical wound so you've fallen there is a swelling those ones have to be looked at for instance they might be bleeding underneath the skin or it's an inflammatory injury maybe after attend on tear or rupture or maybe some ligament have been damaged definitely the body responds by an inflammatory weight it will inflame and swell up such kind of injury as well requires to be seen or maybe there is a fracture which is poking tissues on the inside maybe there's an even an internal bleed such kind of things have to be looked at you know seeing grace a physical wound on the outside but inside there might be some damage I'll even talk about maybe things like those pressure ulcers precious ulcers they don't form by just a wound happening on the skin as someone is lying on one position for too long the bony prominence is pressing against the tissue so the injury begins from the inside by the time you're seeing it outside the entire inside is already compromised so even such that's what we normally advocate for even healthcare workers at home like not everyone's in the facility some people being taken care of from home like doing a physical head to toe examination those we normally call pressure areas I just need to assess and monitor you need to know between the good the good tissue looks like so that when you see the bad tissue can easily identify okay all right interesting and now that there's do we have basics or key principles of wound management I know you said a wound is always supposed to be covered you know are there other basic principles of wound management for someone at home who doesn't have a severe wound I will say yes there are principles and guidelines which should be protocols which should be followed okay one is all wounds have to be covered all wounds have to be covered then two if it's at home you should minimize regular dressing changes these days we are having a lot of technology there are dressings materials which are available which minimizes exposure because remember the environment at home might not be completely ideal to expose wounds because possibility of contamination from different surfaces or even from the provider at home so there's no ideal environment for opening a wound at home yes you can be able to create it but it's not that easy so appropriate dressing material most of them can even do five to seven days without change of dressing it enhances quicker healing there is less interference with the the healing process but that one has to be prescribed if not a medical practitioner is coming to do it you should have been given some basic information on how to achieve this serility process how to do the changes because at times maybe you find the hospital is expensive to take the patient but you can be able to learn and do it from home then reporting you need to be reporting to a certain healthcare practitioner that I have exposed this is how it looks this is how it was this is how it looks like now is there anything of concern that you need to adjust or maybe should we bring the patient for a review so even if you're managing the patient at home you need to also I associate with a certain facility but you can be able to be reporting on the progress okay all right let's now talk about the the band for for the band is there what is the best fast aid to do order password before they go to even say the doctor in the event maybe there's a chemical band or from a fire what is the best way to handle someone uh bands is a is a is a very uh interesting kind of a wound it's unlike most other wounds uh you are maybe if I just uh tell you the difference you feel that for other wounds uh these are physical injuries maybe it's a cut yeah or uh cells okay now remember your biology uh cells have been cut so they let me just now read down to that one but now for bands uh they're exposed to heat so we normally say the proteins are becomes uh uh denatured doesn't the the cells don't work normally the cell is there as a whole but it doesn't work normally so healing process is extremely slow or if they they're subjected to uh less or negative thermal effect then the cells becomes deactivated cease to stop stops to work completely so that is why bands are funny and healing becomes a little bit difficult uh so subjected to heat uh the first aid normally say you remove uh the the the the course remove the try to remove the also yourself taking precautions not to be the other the next victim i remove the course if the patient was abated to heat uh with caution uh you cool the wound with caution you cool the wound there's several ways you can be able to do that you apply maybe uh a cloth on top and then something cold on top as in you pour liquid or ice but not directly on the wound uh you put something first like a cloth a clean cloth then uh then and also the issue of uh some couldn't have blisters already do you poke the blisters and such as an entire model as well um the home environment is not a guarantee of sterility that's why normally don't poke blisters uh so those ones need to be seen in a facility um after you've removed the the effect if it's an electrical band uh with caution don't go touching they were trying to pull them off from the cables just switch from the mains switch off from the mains uh ensure this patient is in a clear place also you safe distances from electric electrical cables and such uh then uh for electrical uh injuries those patients have to be seen in a facility because electricity normally impairs uh functions including brain conductivity and heart so those ones need to be seen in a facility as soon as possible try to get options of getting to facility for thermal uh uh events or chemical exposures uh those ones we normally uh need depending on the the severity we normally say anything this how we normally uh calculate percentage of bands uh there are those that will indicate hospital admission those that will just be seen as an outpatient they are released to go home so that those categories that need to be seen uh if you can be able to measure with your palm of your hand this is we normally call it one percent so your body will be covered by a hundred of your palm size uh so one percent anything can be covered by your hand okay have it seen by facility though that's something that can be able to be managed from home but have it seen a facility those like from uh uh above uh these days even if it's five percent okay sometime back you used to admit from ten percent these days even anything more as long as it's deep penetrating into the uh deeper tissues uh regardless of the percentage uh might need to be admitted for what we normally call uh early excision and maybe grafting okay in Alema's language remember you talked about uh the cell being deactivated or damaged you know that it's not responding so if you cut that cell out you convert this wound from a band into a cut into a cut oh yes so it heals quicker faster yes okay so now i'm known cuts heal faster than than bands if the tissues are still there if the tissues are still there okay now what about for um the category of people who have pre-existing conditions like diabetes and those that have HIV uh uh those are some other uh mobiles that has to be managed first uh for instance maybe i can talk more about diabetic uh patients you find that they're having limitations in healing uh because diabetes itself has got complications uh the most noticed complication is normally a reduction of blood supply to areas that's why we find uh patients end up with what we call peripheral arterial disease because the arteries uh collapse there is less of a blood flow to extremities you get these patients are subjected to dead tissues and gangrene uh there are those patients who develop what we call neuropathies they cannot be able to perceive sensation they end up with a lot of source all this contributes to what we call uh diabetic foot ulcers and many other related uh ulcers because of uh diabetes so healing normal or maybe to manage them uh manage the underlying conditions first even for those with the HIV like uh you need to boost on the immunity remember the immunity is compromised uh immunity okay nutrition and so forth it's a lot of things that has to be boosted fast so that eventually even the wound can be able to heal uh for instance there are those basic requirements for a wound to heal uh good protein intake uh that's those are the building blocks for tissue regeneration and repair uh to no infection like uh uh treat uh the the infection or maybe the bacteria that have come in and then uh three we normally talk about moisture balance remember some of the tissues uh there's a lot of or too much moisture in the wound because of either the dressing material put on and such then also the type of tissue that you have are you having dead tissue are you having viable tissue check on them so there's a sequence that they normally follow uh which helps you to identify we we're having like we call it like a time principle that is one of the that help you to assess uh time is an acronym like T stands for tissue inflammation infection moisture balance and the edges so some of the uh acronym that makes it simpler to assess and manage the wound there are several others which are common but that's the key one currently okay all right now back to infections because if you don't manage it well I'm assuming that you'll get infections what are the signs that the wound has been infected and how should one go about it uh infection many manifests itself clearly uh one there is okay there are two types of uh infection there is localized infection whereby it's just the wound that is showing manifestation of infection and then two when this patient is having either spreading or systemic infection so when you want to say a wound is infected there are those local manifest local signs uh localized heat comes a little bit warmer than the surrounding uh change of color it becomes red you call it there's a rhythm uh then the the tissue itself might change color uh to darkening because of the infection infection sets into the wound itself we have change of x-dates color x-dates that fluid coming from the wound can change color becomes purulent or maybe it comes uh pass let me call it pass um non healing is another sign of in fact the wound does not respond well it means there's some deep seated infection uh it's a status normally called biofilm uh so there's some of the common signs that can be put find the patient has got local infection when we talk about spreading infection now the the changes of the surrounding skin call it periwound skin starts to change as well the heat spreads to now the surrounding even change of color now the manifestation of systemic infection for instance nausea and vomiting that general weakness system shutdown loss of appetite i know these are systemic signs of an infection which can be originating from just the wound one okay can you manage an infection at home no uh uh you can that is after uh appropriate uh prescriptions uh because you see at times also maybe the hospital environment might let's say these patients who got immune suppression the longer you keep them in hospital there's this risk of a hospital acquired infection so the safest place to manage them is at home okay uh so these patients are put in prescriptions and they can recover from home but definitely if there's an open wound with regular uh or maybe monitored dressing changes all right so apart from infection what are some of the other factors that delay wound healing um no those ones we call them chronicity what causes chronicities and what delays wound healing apart from infection uh then the lying condition we talked about diabetes uh those vascular issues like this limitation of blood supply that is very naughty uh and the lying conditions are many uh we have irritants or even even the kind of dressing put remember some practitioners maybe they don't have the knowledge of uh this dressing materials you can put something on a wound which will complicate it further instead of improving it it makes it uh become worse um other factors like injury uh you get patients they have a wound then they've injured the same place again so uh also normally it makes it take a little bit longer to heal several factors yeah okay all right interesting now you mentioned that this um there's been a lot of change from how wounds are being treated to how it is now so what is this that has changed over time uh i know what what cuts across like now many Kenyans are from the history you've gone to hospital and guys are using honey and sugar i don't know if you you're too young to remember that you could go to a facility and when it comes to time for dressing you think you're in a supermarket there is this type of a sugar brand honey is from somewhere in uh this some of the old methods uh there's some solutions which are used to clean a wound okay uh not really uh uh demeaning the companies manufacturing them like hydrogen peroxide we have some kind of iodine solution in the market this one should never be put on the wood okay science have proven that they are not right being put on the wound they cause more damage on the cells some some you might not see like immediately but in the long term those are some of the factors that contribute to prolonging the healing time so technology has really come in handy to modify and to have a way of managing infection moisture balance and ensuring the tissues come quicker so there are materials that have been uh engineered scientifically engineered to help with that uh for instance i can just mention a few uh technologies we have uh foam dressing foam just like the mattress foam but now this one is a foam dressing a little bit thinner not like not as thick as the mattress so between uh thinner it absorbs at the same time they are impregnated with antibiotics so you see you put on an infected wood this patient doesn't need to take oral antibiotics so to get shots for antibiotics if it's local and local infection just put a local antibiotic to it so it's a dressing it takes up the moisture and releases antibiotics it helps the wound to dry up quicker so it it it removes those older ways whereby you found patients just these are patients directly with gauze you've seen uh just a normal gauze put directly on a wound these are some more things gauze it doesn't it doesn't have any medical benefit on the wound actually it's like a foreign body but these ones have been engineered to absorb so we have others like we call hydrophibers or alginates these ones are put in those deep wounds they stimulate granulation and tissues to come up quick we have any technologies like negative pressure wound therapy it's a device connected on a patient it's portable uh it takes out the x-dates minimizes contamination even post surgery we use them a lot when we're doing post surgical uh management or prevention of what we call surgical site infections uh then interventions like uh uh growth factor concentrate those there's some injection just get blood from just get some blood from you we separate growth factors and everything so growth factors are injected back they stimulate quicker the the same growth factors we use when when uh even regenerating uh hair those with hair thinning and uh partial hair loss which is not really genetic uh so by that it stimulates even hair regeneration so when you even give it to a wound it regenerates a new tissues growth we're having the same of uh the protein rich plasma with the prp injections just from the blood you you know the body is compact it has everything it needs okay so we just get those ones concentrate them and put them back they help these are uh ways of making things up and quicker okay so technology has come to change things up and make things better thank you very much for this amazing insightful conversation Dr. Kennedy is there one thing that you want to advise the youth regarding uh from everything that you've said regarding wound treatment healing and care if you have that that's the camera also you can share your handle where people can get you yeah um for the youths okay this is a it's a it's an interesting uh group uh i know they are the ones who are at risk actually uh most uh trauma related wounds we get them uh affecting this particular age group uh from uh accident fights uh because of exposure they're really trying to explore to explore more so you find that they they end up with a lot of injuries so go slow be careful on uh whatever you're doing whichever activities don't engage in activities that will uh put you at risk of injuries and uh subject you to wounds and uh uh yeah i think that's what i can go tell the youths just to be careful careful with themself right they are at risk of a lot of injuries i know that those that come because of age that this will come because of lifestyle but the majority is those that are caused by trauma trauma wounds uh as in composite of the majority percentage yes so the common type yes yes so and the youths are the ones who are at at risk very active yeah uh to get me uh on my social handles uh k medicine consult that cuts across all the social platforms k medicine consult uh i'm available at uh 40 suits upper hill uh those for those who wants to physically come to to see me at a clinic okay thank you very much dr kennedy we appreciate you sharing uh the insightful uh comments on this particular topic that has been us discussing on uh you know wound healing treatment and uh care with dr kennedy i hope you've taken something from it you bring a youth make sure you tread carefully when you're having fun out there whatever you do make sure you take 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